Preventative double mastectomies on the rise

Angelina Jolie is the latest in a string of famed women to announce she’s had risk-reducing breast surgery after discovering she carries a breast cancer (BRCA) gene. Before her, Michelle Heaton and Sharon Osbourne have also had this major surgery, which can reduce the risk of breast cancer by up to 95%. But what does surgery involve? What are the BRCA genes and how do you know whether you carry one? And while the benefits are clear, what about the risks and disadvantages of preventative surgery? Are there other options for reducing your risk? In this blog, we discuss all of this.

BRCA genes and breast cancer

While risk factors for cancer usually include things like age, lifestyle and diet, in a small number of cases (5–10%), cancer is thought to be caused by an inherited faulty gene. The genes most commonly linked to an increased risk of breast cancer are BRCA1 and BRCA2 (BRCA stands for breast cancer). This means that if there is a faulty BRCA gene in your family, those who inherit it will be at a greater risk of breast cancer than the general population.

If you’re worried about cancer in your family, you may want to tell your GP if you've had:

three close blood relatives from the same side of the family who developed breast cancer at any age

two close relatives from the same side of the family who developed breast cancer under 60

one close relative who developed breast cancer aged 40 or younger

a close male relative with breast cancer

a close relative with breast cancer in both breasts.

Online self-assessment tool

If there’s a history of breast or ovarian cancer in your family, use our online tool OPERA to check your risk. OPERA gives you a personalised assessment of your risk with further information and support.

If your GP thinks there may be an increased risk of cancer in your family, they’ll refer you to a genetic counsellor or cancer specialist to assess your cancer risk. You may be offered genetic testing if your family history makes it likely that you may have inherited one of the BRCA genes.

Options if you’re at increased risk

If your GP or genetic counsellor tells you that, based on your family’s history, you may be at an increased risk of cancer, there are several possible options for managing your risk, whether you had a genetic test or not. These include:

Risk-reducing mastectomy is major surgery involving a general anaesthetic. During the operation the surgeon removes both breasts.

There are different types of surgery. A total mastectomy removes the breasts, nipples, areola (the coloured skin around the nipple), and about half of the skin covering the breasts. Various other types of operation preserve the skin of the breasts, the nipple and/or the areola.

Breast reconstruction is an operation to make a new breast shape after a mastectomy. It can be done at the same time as risk-reducing mastectomy (immediate reconstruction) or some time later (delayed reconstruction).

The new breast shape can be made with a breast implant, by using tissue taken from another part of your body, or by a combination of both techniques.

After the operation, most women say they feel much less anxious about getting breast cancer and the impact it could have on their family.

You won’t need to have breast screening.

Disadvantages

It can take up to six months or more to fully recover.

As with all operations, there can be complications.

Your body won’t look the same and you may not be happy with the change.

You may not develop breast cancer anyway, even if you don’t have the operation.

The results of the surgery are permanent. You can’t change your mind once you’ve had the operation.

If you’re having breast reconstruction as well, you’re likely to need more than one operation to get the best cosmetic result.

Coping with cancer in the family

Living with the threat of cancer in your family can be very difficult. Talking about your worries with relatives may help. If you find it difficult to talk to your relatives, getting support from a partner, genetic counsellor or friend may help.

If you feel that risk-reducing breast surgery isn’t right for you at this time, or you’re unsure about it, talk to your GP or a genetic counsellor about the other options available.

Ideas for blog posts? Let us know.Comments? Feel free to add them below (you need to be logged in). If you can't see the comment box, click on this blog's title at the top.Keep in touchFollow Macmillan’s cancer information team on Twitter @mac_cancerinfo

For all of you thinking about this operation keep in mind that is very very painful.
If you think about going ahead please please...
Ask your doctor to perform a Pecs block on you!
Takes the pain away completely in minutes.
It is my contribution to all of you.
Sincerely
A clever friend

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